Interrupted Stay Policy Frequently Asked Questions (FAQs) and Resources-Interrupted Stay Policy Frequently Asked Questions (FAQs) and Resources

Interrupted Stay Policy Frequently Asked Questions (FAQs) and Resources

Pdf Summary

The Interrupted Stay Policy, detailed in the AAPACN FAQs and Resources, outlines Medicare Part A rules for skilled nursing facility (SNF) stays interrupted by short gaps of less than three non-covered days. This policy allows such interruptions to be treated as one continuous Medicare stay rather than separate stays, impacting assessments, billing, and payment schedules.<br /><br />Key points include:<br />- Definition: An interrupted stay occurs when a Medicare Part A resident is discharged from SNF care and returns to the same SNF for Medicare-covered care within a 3-day interruption window (discharge day plus two calendar days, ending at 11:59 pm on the third day).<br />- Impact: The stay is continuous, so no Part A PPS Discharge assessment or new 5-Day PPS assessment is needed upon return. Payment and Variable Per Diem (VPD) schedules remain uninterrupted. However, OBRA discharge and entry tracking assessments may still be required based on circumstances.<br />- Billing: The stay is billed as one continuous claim. Non-covered interruption days are reported using occurrence span code 74 on Medicare claims, but Medicare is not billed for those days.<br />- Multiple interruptions can occur in one benefit period as long as each meets the policy criteria.<br />- Hospital admissions during the interruption window count toward an interrupted stay if the resident returns within the 3-day period.<br />- An interrupted stay only applies if the resident resumes Medicare Part A skilled care; returning for other reasons like hospice does not qualify.<br />- Medicare Advantage plans may vary in adopting this policy.<br />- Assessment schedules: The 5-Day PPS assessment can be adjusted around the interruption or scheduled after return, but OBRA assessments follow separate rules. Electronic health records sometimes incorrectly prompt unnecessary assessments due to setup issues.<br />- MDS coding and dates must reflect the continuity of the interrupted stay, with specific guidance for entries such as A0310G1 and A2400C.<br />- Therapy and service data count only from the resident’s latest entry/reentry date.<br />- Physician certification and recertification timelines continue unaffected by interruptions.<br />- Beneficiary Notices Initiative (BNI) actions are not triggered solely by an interrupted stay and remain based on coverage and discharge status.<br />  <br />Practical examples illustrate scenarios of returns within or outside the interruption window, explaining assessment and billing consequences. Tools like flow charts, quick guides, and interactive trackers are provided by AAPACN to assist facilities in correctly applying the interrupted stay policy.<br /><br />Overall, the policy helps avoid unnecessary reassessments and payment resets for short breaks in Medicare Part A SNF stays, ensuring billing and care coordination continuity for residents.

Keywords

Interrupted Stay Policy

Medicare Part A

Skilled Nursing Facility

SNF stays

3-day interruption window

PPS Discharge assessment

Billing and payment schedules

Occurrence span code 74

OBRA assessments

Medicare Advantage plans